MEDICARE: DR. NADYA HOLLAHAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist	PSY003278	GA

General Provider Information

NPI Number	:	1699969709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADYA HOLLAHAN PH.D.

Provider Business Mailing Address
First Line	:	2131 WOODMOOR LN
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5440
Country	:	US
Telephone Number	:	678-358-7112
Fax Number	:	678-261-6545

Provider Business Practice Location Address
First Line	:	1955 CLIFF VALLEY WAY NE
Second Line	:	SUITE 115
City	:	ATLANTA
State	:	GA
Zip	:	30329-2476
Country	:	US
Telephone Number	:	678-358-7112
Fax Number	:	678-261-6545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	11/06/2009

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